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Canadian Institute of Actuaries. L’Institut canadien des actuaires. 2009 Seminar for the Appointed Actuary Colloque pour l’actuaire désigné 2009. Recent Judicial Developments. Presented to Canadian Institute of Actuaries September 18, 2009 By: Randy Bundus

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2009 seminar for the appointed actuary colloque pour l actuaire d sign 2009 l.jpg

Canadian

Institute

of

Actuaries

L’Institutcanadien

des

actuaires

2009 Seminar for the Appointed Actuary

Colloque pour l’actuaire désigné 2009


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Recent Judicial Developments

Presented to

Canadian Institute of Actuaries

September 18, 2009

By: Randy Bundus

Vice President & General Counsel

Insurance Bureau of Canada

2009 Seminar for the Appointed Actuary

Colloque pour l’actuairedésigné 2009


Topics l.jpg

Minor Injury Cap Challenges

Alberta

Nova Scotia

New Brunswick

P.E.I.

DeKoning v. Vector Insurance and Wawanesa

MacNeil v. DeKoning and Bryan

Danilov v. Unifund

2009 Seminar for the Appointed Actuary

Colloque pour l’actuairedésigné 2009

Topics


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Nova Scotia Cap and “Minor Injury” Definition

Insurance Act

S.113B (1) In this Section,

(a) “minor injury” means a personal injury that

(i) does not result in a permanent serious disfigurement,

(ii) does not result in a permanent serious impairment of an important bodily function caused by a continuing injury which is physical in nature, and

(iii) resolves within twelve months following the accident;

(b) “serious impairment” means an impairment that causes substantial interference with a person’s ability to perform their usual daily activities or their regular employment.

2009 Seminar for the Appointed Actuary

Colloque pour l’actuairedésigné 2009


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Nova Scotia Cap and “Minor Injury” Definition

S.113 B (4)

(4) Notwithstanding any enactment or any rule of law, but subject to subsection (6), the owner, operator or occupants of an automobile, any person present at the incident and any person who is or may be vicariously liable with respect to any of them, are only liable in an action in the Province for damages for any award for pain and suffering or any other non-monetary loss from bodily injury or death arising directly or indirectly from the use or operation of the automobile for a minor injury to the amount prescribed in the regulations.

2009 Seminar for the Appointed Actuary

Colloque pour l’actuairedésigné 2009


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Nova Scotia Cap and “Minor Injury” Definition

Automobile Insurance Tort Recovery Limitation Regulation

2(1)(d) “personal injury” does not include

(i) a coma resulting in a continuing serious impairment of an important bodily function

(ii) chronic pain -

(A) is diagnosed and established as chronic pain by a medical specialist appropriately trained in the diagnosis and management of pain disorders,

(B) is a direct result of a physical injury sustained in the motor vehicle accident with respect to which the claim is brought,

(C ) results in a continuous serious-impairment of an important bodily function, and

(D) is moderately severe or severe pain, as classified in the American Medical Association Guides to the Evaluation of Permanent Impairment, 5th edition,

2009 Seminar for the Appointed Actuary

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Nova Scotia Cap and “Minor Injury” Definition

(iii) a burn resulting in serious disfigurement,

(iv) an amputation of a major limb;

2(1)(f) “resolves” means

(i) does not cause or ceases to cause a serious impairment of an important bodily function which results from a continuing injury of a physical nature to produce substantial interference with the person’s ability to perform their usual daily activities or their regular employment, or

(ii) causes a serious impairment which results from a continuing injury of a physical nature to produce substantial interference with a person’s ability to perform their usual daily activities or their regular employment where the person has not sought and complied with all reasonable treatment recommendations of a medical practitioner trained and experienced in the assessment and treatment of the personal injury;

2009 Seminar for the Appointed Actuary

Colloque pour l’actuairedésigné 2009


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Nova Scotia Cap and “Minor Injury” Definition

2(1)(g) “substantial interference” means, with respect to a person’s ability to perform their regular employment, that the person is unable to perform, after reasonable accommodation by the person or the person’s employer for the personal injury and reasonable efforts by the injury person to adjust to the accommodation, the essential elements of the activities required by the person’s pre-accident employment;

2(1)(h) “usual daily activities” means the essential elements of the activities that are necessary for the person’s provision of their own care and are important to people who are similarly situated considering, among oth4er things, the injury person’s age.

Total amount recoverable for non-monetary losses

3. For the purpose of subsection 113B(4) of the Insurance Act, the total amount recoverable as damages for non-monetary losses of a plaintiff for all minor injuries suffered by the plaintiff as a result of an incident must not exceed $2,500.

2009 Seminar for the Appointed Actuary

Colloque pour l’actuairedésigné 2009


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Alberta Cap and “Minor Injury” Definition

Alberta Insurance Act

S.650.1(1) In this section, “minor injury” means an injury as defined or otherwise described by regulation as a minor injury.

S.650.1.(2) In an accident claim, the amount recoverable as damages for non-pecuniary loss of the plaintiff for a minor injury must be calculated or otherwise determined in accordance with the regulations.

2009 Seminar for the Appointed Actuary

Colloque pour l’actuairedésigné 2009


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Alberta Cap and “Minor Injury” Definition

Minor Injury Regulation

1. For the purpose of section 650.1of the Act and this Regulation,

(h) “minor injury”, in respect of an accident, means

(i) a sprain,

(ii) a strain, or

(iii) a WAD injury

caused by that accident that does not result in a serious impairment;

(j) “serious impairment”, in respect of a claimant, means an impairment of a physical or cognitive function

2009 Seminar for the Appointed Actuary

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Alberta Cap and “Minor Injury” Definition

(i) that results in a substantial inability to perform the

(A) essential tasks of the claimant’s regular employment, occupation or profession, despite reasonable efforts to accommodate the claimant’s impairment and the claimant’s reasonable efforts to use the accommodation to allow the claimant to continue the claimant’s employment, occupation or profession,

(B) essential tasks of the claimant’s training or education in a program or course that the claimant was enrolled in or had been accepted for enrolment in at the time of the accident, despite reasonable efforts to accommodate the claimant’s impairment and the claimant’s reasonable efforts to use the accommodation to allow the claimant to continue the claimant’s training or education, or

2009 Seminar for the Appointed Actuary

Colloque pour l’actuairedésigné 2009


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Alberta Cap and “Minor Injury” Definition

(C ) normal activities of the claimant’s daily living,

(ii) that has been ongoing since the accident, and

(iii) that is expected not to improve substantially;

(k) “sprain” means an injury to one or more tendons or ligaments, or to both;

(n) ”WAD injury” means a whiplash-associated disorder other than one that exhibits one or both of the following:

(ii) objective, demonstrable, definable and clinically relevant neurological signs;

(iii) a fracture to or a dislocation of the spine.

2009 Seminar for the Appointed Actuary

Colloque pour l’actuairedésigné 2009


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Alberta Cap and “Minor Injury” Definition

6(2) Subject to this section and section 7(2)(a), for the purposes of section 650.1(2) of the Act, the total amount recoverable as damages for non-pecuniary loss for all minor injuries sustained by a claimant as a result of an accident is $4,000.

6(3) For the 2007 and subsequent calendar years, the minor injury amount shall be increased annually, with effect from January 1, by an amount equal to ….

2009 Seminar for the Appointed Actuary

Colloque pour l’actuairedésigné 2009


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New Brunswick Cap and “Minor Injury” Definition

Insurance Act

265.21(1) In this section “soft tissue injury” shall be as prescribed and defined in the regulations.

265.21(2) In an action for damages arising out of an accident, the amount recoverable as damages for the non- pecuniary loss of the plaintiff for soft tissue injury shall not exceed the amount set out in the regulations.

265.21(3) In an action for damages arising out of an accident, the amount recoverable as damages for the non- pecuniary loss of the plaintiff for minor personal injury shall not exceed the amount set out in the regulations.

265.21(4) This section applied only to accidents occurring on or after the commencement of this section.

2009 Seminar for the Appointed Actuary

Colloque pour l’actuairedésigné 2009


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New Brunswick Cap and “Minor Injury” Definition

Injury Regulation

2(2) In this Regulation and for the purposes of section 265.21 of the Act “minor personal injury” means an injury that does not result in

(a) permanent serious disfigurement or

(b) permanent serious impairment of an important bodily function caused by continuing injury which is physical in nature;

“serious impairment” means an impairment that causes substantial interference with a person’s ability to perform their usual daily activities or their regular employment.

2009 Seminar for the Appointed Actuary

Colloque pour l’actuairedésigné 2009


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New Brunswick Cap and “Minor Injury” Definition

Application

3 This Regulation only applies to minor personal injury suffered by a plaintiff as a result of an accident that occurs on or after July 1, 2003.

Maximum recoverable amount

4 For the purposes of subsection 265.21(3) of the Act, the total amount recoverable as damages for the non-pecuniary loss of the plaintiff for all minor personal injury suffered by the plaintiff as a result of an accident shall not exceed $2,500.

2009 Seminar for the Appointed Actuary

Colloque pour l’actuairedésigné 2009


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P.E.I. Cap and “Minor Injury” Definition

Insurance Act

Damages

254.1(1) In this section

(a) “accident” means an accident arising out of the use or operation of an automobile;

(b) “minor personal injury” means an injury that does not result in

(i) permanent serious disfigurement, or

(ii) permanent serious impairment of an important bodily function caused by continuing injury that is physical in nature.

2009 Seminar for the Appointed Actuary

Colloque pour l’actuairedésigné 2009


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P.E.I. Cap and “Minor Injury” Definition

(c ) “plaintiff” means a plaintiff in an action for damages arising out of an accident;

(d) “serious impairment” means an impairment that causes substantial interference with a person’s ability to perform his or her usual daily activities or his or her regular employment.

254.1(2) In an action for damages arising out of an accident, the amount recoverable as damages for the non- pecuniary loss of the plaintiff for minor personal injury shall not exceed $2,500.

254.1(3) This section does not apply to an action for damages in respect of an accident occurring prior to April 1, 2004, 2003, c.,s.3.

2009 Seminar for the Appointed Actuary

Colloque pour l’actuairedésigné 2009


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Canadian Charter of Rights and Freedoms

Rights and Freedoms in Canada

1. The Canadian Charter of Rights and Freedoms guarantees the rights and freedoms set out in it subject only to such reasonable limits prescribed by law as can be demonstrably justified in a free and democratic society.

Life, Liberty and Security of Person

7. Everyone has the right to life, liberty and security of the person and the right not to be deprived thereof except in accordance with the principles of fundamental justice.

2009 Seminar for the Appointed Actuary

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Canadian Charter of Rights and Freedoms

Equality Before and Under Law and Equal Protection and Benefit of

Law/Affirmative action programs.

15.(1) Every individual is equal before and under the law and has the right to the equal protection and equal benefit of the law without discrimination and, in particular, without discrimination based on race, national or ethnic origin, colour, religion, sex, age or mental or physical disability.

15.(2) Subsection (1) does not preclude any law, program or activity that has as its object the amelioration of conditions of disadvantaged individuals or groups including those that are disadvantaged because of race, national or ethnic origin, colour, religion, sex, age or mental or physical disability.

2009 Seminar for the Appointed Actuary

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Alberta Challenge

Plaintiff’s Arguments

Defendant’s Arguments

Justice Wittman’s Decision

Court of Appeal Decision

Status

2009 Seminar for the Appointed Actuary

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Nova Scotia Challenge

Plaintiff’s Arguments

Defendant’s Arguments

Justice Goodfellow’s Decision

Status

2009 Seminar for the Appointed Actuary

Colloque pour l’actuairedésigné 2009


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New Brunswick Challenge

Status

2009 Seminar for the Appointed Actuary

Colloque pour l’actuairedésigné 2009


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P.E.I. Challenge

Status

2009 Seminar for the Appointed Actuary

Colloque pour l’actuairedésigné 2009


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DeKoning v. Vector Insurance and Wawanesa

Moving Violation as Change Material to the Risk?

MacNeil v. DeKoning and Bryan

High water mark for B.I. Damages

2009 Seminar for the Appointed Actuary

Colloque pour l’actuairedésigné 2009


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Danilov v. Unifund

SABS “First Insurers”

“Sufficient Nexus”

Status

2009 Seminar for the Appointed Actuary

Colloque pour l’actuairedésigné 2009


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